Patient satisfaction after remotely delivered gut-directed hypnotherapy for irritable bowel syndrome during the COVID-19 era: implications for future practice.

OBJECTIVE: Gut-directed hypnotherapy (GDH) is an evidence-based treatment for irritable bowel syndrome (IBS). Adoption of remote GDH has been accelerated by the COVID-19 pandemic. We aimed to evaluate patient experience and satisfaction following remote GDH. DESIGN: On completing 12 sessions of remote GDH via Skype using the Manchester protocol, patients with refractory IBS completed a feedback form on their experience. The proportion reporting positive outcomes (≥30% improvement in global IBS symptoms or abdominal pain, satisfaction, recommendation to family/friends) were compared by patient factors (age, gender, proximity, preferences). RESULTS: Of 52 patients completing the feedback form, 27 (52%) indicated that they would have opted for remote over face-to-face GDH, regardless of the pandemic situation. On a five-point scale (5=easy), patients rated the platform easy-to-use (mean 4.5±0.8) without impairment of communication (mean rating 4.6±0.8). Following remote GDH, 30/52 (58%) reported ≥30% global IBS symptom improvement, and 24/52 (46%) reported ≥30% pain reduction. 90% would recommend remote GDH to others. Only 39% felt they would have benefitted more from face to face. Those who would have chosen remote GDH regardless of the pandemic were more likely to be satisfied (p=0.01). Age, gender and proximity did not influence outcomes, satisfaction and likelihood of recommending remote GDH to others. Difficulties during remote sessions were infrequent in both those that were satisfied, and those that would have preferred face to face. CONCLUSION: These data support the need to continue developing remote GDH in the post-COVID era but suggest that there is still a role for face-to-face GDH, with patient choice being an important factor.

The symptom burden of Irritable Bowel Syndrome in tertiary care during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic caused unprecedented disruption to healthcare services worldwide with well-documented detrimental effects on mental health. Patients with refractory disorders of gut-brain interaction such as Irritable Bowel Syndrome (IBS) seen in tertiary care tend to exhibit higher levels of psychological comorbidity, but the impact of the pandemic on IBS symptom severity in tertiary care is unknown. METHODS: As part of routine clinical care, consecutive tertiary referrals with refractory IBS patients prospectively completed a series of baseline questionnaires including IBS symptom severity score (IBS-SSS), non-colonic symptom score, Hospital Anxiety and Depression (HAD), and Illness impact scores. The symptom severity questionnaire data were compared for consecutive patients seen in tertiary care 12 months before and after the onset of COVID-19 pandemic restrictions. KEY RESULTS: Of 190 consecutive tertiary referrals with IBS, those seen during the pandemic had greater IBS severity (IBS-SSS: 352 vs. 318, p = 0.03), more severe extra-intestinal symptoms (non-colonic score: 269 vs. 225, p = 0.03), sleep difficulties (p = 0.03), helplessness and loss of control (p = 0.02), but similar HAD-Anxiety (p = 0.96) and HAD-Depression (p = 0.84) scores. During the pandemic, unmarried patients (p = 0.03), and keyworkers (p = 0.0038) had greater IBS severity. CONCLUSIONS AND INFERENCES: This study has shown for the first time that patients seen in tertiary care with refractory IBS during the COVID-19 pandemic had a significantly higher symptom burden emphasizing the importance of gut-brain axis in IBS. Furthermore, lack of support and perceived loss of control appear to be contributory factors.

The symptom burden of irritable bowel syndrome in tertiary care during the Covid-19 pandemic

IntroductionRecent data on the natural history of Irritable Bowel Syndrome (IBS) highlight the prognostic importance of extra-intestinal and psychological symptom profiles. Those with a high psychological burden have been shown to have the worst prognosis, and are consequently most likely to be referred to tertiary care. The Covid-19 pandemic caused significant disruption to tertiary services and affected the mental health of the nation, however there is minimal data on the effects on patients with IBS in tertiary care. We therefore compared the symptom profiles of tertiary referrals with refractory IBS, 12-months before, and 12-months after the onset of Covid-19 restrictions in the UK.MethodsAs part of their routine care, all patients with refractory IBS referred to the tertiary service before and after the Covid-19 pandemic prospectively completed a series of questionnaires during their baseline consultation including;IBS symptom severity score (IBS-SSS), non-colonic symptom score, Hospital Anxiety and Depression (HAD), and Quality of Life (QoL). Demographic data and symptom profiles were compared between patients seen in the 12 months before the pandemic (22/03/2019 - 22/03/2020) with those seen in the 12-months after (23/03/2020 - 23/03/2021), using non-parametric tests.ResultsOverall, 190 patients (median age 43 years, n=157 (82.6%) female, 41.0% IBS-C, 24.7% IBS-D, IBS-M 33.7% and 0.5% IBS-U) with refractory IBS were included. Compared to those seen in the 12-months before the pandemic (n=107), the cohort seen during the Covid-19 pandemic (n=83) had a significantly higher median IBS-SSS (318 vs. 352, p=0.03), and more extra-intestinal symptoms (non-colonic score: 225 vs. 269, p=0.03). During the pandemic, median abdominal pain (50 vs. 63, p=0.05) and abdominal distension scores (60 vs. 75, p=0.008) were significantly higher, and patients that were unmarried had a higher median IBS symptom severity (IBS-SSS: 320 vs. 359, p=0.03). Interestingly, those seen during the pandemic had more difficulty with sleep (53 vs. 68, p=0.03), and more feelings of helplessness and loss of control (50 vs. 70, p=0.02), compared to those seen before the pandemic. There was no difference in the levels of anxiety and depression between the pre and post lockdown groups (HAD-Anxiety: 11 vs. 11.5, p=0.96;HAD-Depression: 8 vs. 8, p=0.84).ConclusionsThis study has shown for the first time that patients seen in tertiary care with refractory IBS during the covid-19 pandemic had a significantly higher symptom burden emphasising the importance of gut-brain axis in IBS. Furthermore, lack of support and perceived loss of control appear to be contributory factors.